PROJECT SPECIALIST (Medical Review Services) - REMOTE

About iMPROve Health

Come join the iMPROve Health team!

iMPROve Health is Michigan's Medicare-designated Quality Improvement Organization, and we're proud to be recognized as both a Cool Place to Work by Crain's Detroit Business (four years running) and one of Modern Healthcare's Best Places to Work in Healthcare.

As a nonprofit with more than 40 years of experience, we're dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better.

This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees' growth through professional development and continuing education opportunities.

At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals---including physicians, nurses, and experienced consultants---partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.

Join us in making a meaningful impact on healthcare---one improvement at a time.

Project Specialist (Medical Review Services)

The Project Specialist plays a critical role supporting medical review services across multiple active contracts, with a strong focus on processing and coordinating external reviews for insurance denial appeals and the peer review process. This position is responsible for coordinating contract-specific case work, performing data analysis, and ensuring timely, accurate handling of cases in a high-volume, fast-paced environment.

This role requires a tech-savvy, self-driven, and highly motivated professional who thrives on managing complex workflows, multiple priorities, and detailed administrative processes.

Key Responsibilities

• Process and facilitate external and peer reviews in alignment with contract requirements, ensuring accuracy, timeliness, and compliance
• Support and coordinate activities across multiple concurrent contracts, managing competing priorities and deadlines
• Track, analyze, and report on case data using internal systems and review service portals
• Develop and maintain forms, reports, templates, and other business documentation
• Provide administrative and operational support to team members, providers, and clients
• Collaborate and facilitate cross-functional projects and initiatives
• Coordinate meetings, trainings, and team events
• Ensure compliance with applicable regulations (HIPAA, FISMA, URAC, CMS)
• Perform other duties as assigned

Qualifications

• Associate's degree or 5 years relevant experience required; Bachelor's degree in a healthcare-related field preferred
• 2+ years of project or administrative support experience required
• Project management skills required; CAPM preferred
• Direct experience processing appeals, (internal/external) or peer reviews strongly preferred
• Proven ability to manage high-volume workloads across multiple contracts
• Strong written and verbal communication skills
• Highly organized with excellent attention to detail and deadlines
• Self-driven with the ability to work independently in a fast-paced environment

Technical Skills

• Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams)
• Experience with project management tools (e.g., Asana)
• Strong technical aptitude and ability to quickly learn multiple systems and portals
• Experience working with web-based platforms and data systems
• Ability to analyze data and develop reports/spreadsheets

Key Competencies

• Ability to manage multiple contracts and complex appeal workflows simultaneously
• Strong problem-solving and critical-thinking skills
• High level of accuracy in handling sensitive, regulated information
• Independent, proactive, and results-driven work style
• Clear, professional communication across diverse stakeholders

This is a fully remote position.

EEO/VET/Disability Employer